Fax: 435-655-2388 Specific changes in the program will be made by the physician as appropriate for the individual patient. Distal Fem & Prox Tib Microfracture App by J. Baumfeld, MD, M. Lemos, MD 2_2014 Compiled by K. DelPaine, PT Review date 3_16 2 Overview In the knee the articular cartilage at the femoral condyles, tibial plateau and patella can be damaged or torn during athletic trauma or injury causing an articular cartilage lesion. Once there is enough healing to go back to basic activities such as walking without crutches then the real work begins. We spend a lot of time and effort perfecting our skills and abilities, we do not need to spend time watching exercises. Open reduction and internal fixation (ORIF) is a type of surgery used to stabilize and heal a broken bone. Education: surgery, healing time, anatomy, rehab phases Encourage ADL Rest and elevation to control swelling Control pain Hip and knee AROM . If you have an emergency during that time, please hang up and call 911. At this stage the surgeon ensures that everything done in therapy is within the bounds of what the surgeon recommends based on the structural integrity of the Tibia. At 2-4 weeks s/p, initiate weight-bearing as tolerated with crutches 2. Breaking both the tibia and fibula together is devastating. Tibial Plateau ORIF Rehabilitation Protocol Download Tibial Plateau ORIF Rehab Protocol Tibial Plateau ORIF Protocol 0-6 Weeks Post Op Non weight bearing x 6 weeks Brace 0-90 (unlocked) for 6 weeks (unless otherwise specified) Pain/edema control, modalities as needed Knee PROM and AAROM to 90 degrees Quad strengthening to gain full extension It's designed to bear most of your body weight when you're . The most common mechanism of injury is motor vehicle accident, Any excessive swelling should lead to slowing of PT. Tel: 801-743-4500435-655-6600 Our clinics are open: As the strength of the bone and muscle builds, more activity is allowed. So whether youre Alex Smith coming back to the NFL, or just trying to get rid of knee pain while you are running, the skill and passion of your physical therapist helping you to heal in the right environment is the key to a speedy recovery. hb``g``g```lYLBZP The footage of the Washington Redskins quarterback, Alex Smith, breaking both of these bones is hard to watch. During the period of non-weight bearing recovery, rehabilitative procedures can be done to encourage healing. Part of what makes Alex Smiths recovery favorable is access to top quality care. Rehabilitation Protocol: ORIF Tibial Plateau Fracture W e i g h t Be a r i n g RO M Br a c e Us e T h e r a p e u ti c E l e me n ts PHASE I 0 - 4 weeks 4 - 6 weeks T o u ch -d o wn we i g h t b e a ri n g (T DW B ) wi t h cru t ch e s. T DW B wi t h cru t ch e s. O b t a i n f u l l e xt e n si o n n o w. Any excessive swelling should lead to slowing of PT. (T<. 63d1= xBH!m`'= The information is the property of Massachusetts General Hospital and should not be copied or otherwise used without express permission of the Director of MGH Physical & Occupational Therapy Services. Contact us to make an appointment. 900 Round Valley Drive, Suite 100 endstream endobj startxref Murray, Utah 84107 %B r]! The athlete will return to weight bearing activities after the bone has healed. Before reaching the point of walking we have to ensure that all the component of walking is intact. A really great physical therapist will also incorporate care for scar tissue and tissue mobility. Depending on the severity of the break and the complexity of the surgery that time could be even longer. Any drainage from the wound 2. WEIGHT BEARING PERIOD OF PHYSICAL THEARPY BEGINS. According to ORIF fibula fracture post-operative protocol there are 4 phases in rehabilitation of fibular fracture: [17] Phase 1- Maximum protection (weeks 0 to 6) Cast or boot for 6 weeks Elevate the ankle above the heart Non-weight bearing x 6 weeks Multi-plane hip strengthening Core and upper extremity strengthening The tibia and fibula are the two bones of the lower leg. This is the time when the muscles are weakest from disuse and the freshly healed bone is fragile. Just like a load-bearing wall in a house, the tibia is integral to our physical structure and without it we cant stand up. By signing this referral, I certify that I have examined this patient and physical therapy is medically necessary. But these things are just the framework for good physical therapy care. hbbd```b``"@$fzD2Wea2`DrMfHgx$4 k I`0,$tL,#]L_ c 4 0 obj Type A - Fractures below the tibial plafond and typically transverse. Internal fixation refers to the fixation of screws and / or plates to enable or facilitate healing. The footage of the Washington Redskins quarterback, Alex Smith, breaking both of these bones is hard to watch. Any drainage from the wound REHABILITATION GUIDELINES: TIBIAL PLATEAU FRACTURE OPEN REDUCTION INTERNAL FIXATION STAGE 1 (Day 1 - 4 weeks): ROM: ASK SURGEON: hinged brace locked in full extension, pillow under calf with leg elevated, patellar mobilizations, gradually increase ROM 0-90 degrees, brace during sleep for 6 They can also be classified by the mechanism or direction of force applied to the injured ankle. It's the front and center of your knee's ligament structure and is also embedded in the knee cartilage (knee cap). Phase II: Weeks 3-6. New West sports medicine & orthopaedic surgery Phone: 2810 W. 35th Street Kearney, NE 68845 (308) 865-2570 or (800) 408-1689 ORIF TIBIAL TUBERCLE PROTOCOL I. lt=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s" title=""-/W3C/DTD XHTML 1.0 Strict/EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-s">. It is recommended that clinicians collaborate closely with the referring physician regarding the timeframes for progression. Distal tibial physeal fractures are classified by the Salter-Harris classification. This protocol provides you with general guidelines for initial stage and progression of rehabilitation according to specified time frames, related tissue tolerance and directional preference of movement. Tibia fracture physiotherapy rehab protocol The goal of the surgical and rehabilitative team focuses on the return of a patient to their previous level of function often in the setting of competing for short-term goals 2. Tibial Plateau Fracture Post-Operative Protocol - Rosenberg Cooley Metcalf Orthopedic Clinic Home / Patient Information / Knee Information / Knee Post-op Care & Rehab / Tibial Plateau Fracture Post-Operative Protocol Phase I - Maximum Protection (0 to 1 weeks): 0 to 1 week: Ice and modalities to reduce pain and inflammation Office Hours Weight distribution onto the broken leg is performed in carefully selected stages, starting slowly and with light weight at first. QUALITY OVER QUANTITY: WHAT TO LOOK FOR IN GREAT PHYSICAL THERAPY We work with organisations big and small To restore full muscle length and flexibility, To improve cardiovascular fitness and muscle endurance, Non weight bearing activities progressed to partial weight bearing activities, Passive (assisted) range of movement exercises for affected leg (knee, ankle etc), Strengthening and range of movement exercises for unaffected leg, Continuation of modalities for pain and swelling, Passive (assisted) and active (independent) range of movement exercises, Strengthening exercises for muscles of affected leg (calf, hamstring, quadriceps etc), Stretching exercises for muscles of affected leg (calf, hamstring, quadricep etc), Range of movement, strengthening and stretching exercises for unaffected leg, Progression of weight bearing full weight bearing activities if possible, Strengthening exercises for muscles in affected and unaffected leg (calf, hamstring, quadriceps, tibialis anterior etc). Guidelines WB as tolerated with or without crutches in Air Cast Boot If you have any questions regarding this protocol, please contact the UGH Orthopedics and Sports Medicine Department at (706) 439-6858. The tibia and fibula are the two bones of the lower leg. Its unusual to break both bones, even in contact sports like football. Strengthening and mobility begin in earnest and can be quite a lot of work. Physiotherapy after tibial plateau fracture fixation: A systematic review of the literature The present literature review illuminates the controversy that exists in the literature about the physiotherapy following tibia plateau fracture fixation. Heber, Utah 84032, 5848 S Fashion Blvd (300 E) Tues. & Wed: 85, Gradual progression to full weight bearing per physician instruction, Strong emphasis on restoring full dorsiflexion, Bilateral progressing to unilateral squat, step and matrix progression, Restoration of full range of motion all planes, Advance ankle and foot intrinsic strengthening, Linear progressing to lateral and rotational functional movements, Bilateral progressing to unilateral plyometric activity, Advance impact and functional progressing, Sport specific drills on field or court with functional brace, Sport test at 3-4 months based on progress. Sunday: 9am - 4pm. If either increase, modify rehab PRICE Ankle Pumps E-stim if Needed Phase I (up to 6 weeks s/p ORIF): Goals: PWB involved LE with or without one crutch DF to neutral Control edema 1. This contributes to the prolonged healing time and requires a period of about 6 weeks where no weight is put on that leg. Please note: Our Online Booking tool is currently down, please contact us on 0330 088 7800 to arrange your appointment and we will honour any online booking discount. 35 0 obj <>/Filter/FlateDecode/ID[<1AB70E5198F416F05DC19BB03B5307E7><648F72BF33933D40AD3625115991231B>]/Index[10 47]/Info 9 0 R/Length 117/Prev 103621/Root 11 0 R/Size 57/Type/XRef/W[1 3 1]>>stream Beside it, more toward the outside of the leg, is the fibula. This is where having a great physical therapist with an extensive skillset, like ours at Rose Physical Therapy Group, is essential. Associate Professor of Orthopaedics Chief, Division of Sports Medicine Tel: (646) 501-7223 Rehabilitation Protocol: Tibial Spine Open Reduction Internal Fixation c. Type C - Fractures above the tibial plafond and associated with syndesmotic injuries. Once an exercise is mastered that exercise becomes part of a home exercise program so that the time spent in therapy is used for the things that cannot be done at home. {2CxX"%2$XpfQp$Qpnp' QhF#a-H)T`|LY28Q2e/*_"n(6p 6 BACK TO BASIC ACTIVITIES The job of the physical therapist is to assess form and to progress things in a safe way to make sure no further injury or re-injury occurs. d!J@uxv&@/ZRGJ7/eqchlL 8. It also means pushing into new boundaries as healing allows. Tibial Plateau Fracture Surgery Rehab Protocol & Recovery Home Tibial plateau fracture Download PDF General Considerations Non-weightbearing status for 4 weeks post-op. 56 0 obj <>stream Office Hours Physical Therapy Guidelines for Ankle Fracture with Surgery This was written and developed by the therapists of MGH Physical Therapy Services. CAUTION: Excessive warmth, redness, swelling, or pain lasting more than 2 days should necessitate a call to our office. Rose Physical Therapy is setup to make the best physical therapy accessible to you by giving our therapists enough time to treat you in an environment that is centered around medical care, convenient to downtown Washington, DC and Capitol Hill / Capitol Riverfront / Navy Yard on the Southeast side of the District. Due to the asymmetrical closure of the distal tibial physis (Figure 1) during early adolescence, transitional fractures can also occur. MondayFriday: 85, 380 E. 1500 S. Suite 103 AROM for ankle, subtalar, midtarsal joints within pain tolerance % Traditionally physical therapy is brought into the equation a little later in the healing process, after the bone has healed enough to begin putting weight on it. With hard work and guidance from a physical therapist strength grows and athletic ability can be regained. ORIF Fibular Fracture Post-Operative Protocol - Rosenberg Cooley Metcalf Orthopedic Clinic Home / Patient Information / Foot & Ankle / ORIF Fibular Fracture Post-Operative Protocol Download as PDF Phase I- Maximum Protection (Weeks 0 to 6) Cast or boot for 6 weeks Elevate the ankle above the heart Non-weight bearing x 6 weeks WWW.TMISportsmed.com Home to the Texas Rangers MD Ph 817-419-0303 3533 Matlock Road, Arlington, Texas, 76015 MD FAX 817-468-5963 %PDF-1.5 % 10 0 obj <> endobj Its a slow journey. Goals Allow healing while maintaining upper body, core, hip/knee strength and ROM . If you have an immediate need, please call 920-480-6993 to be transferred to our answering service . However, a skilled PT would recommend starting gentle therapies before that to maximize outcomes and improve tolerance to harder therapies later on. _HhKvGqf[w+c52|t/;i~=1]` DnO//q@r._+>&8I9,ulPeWp+:9 e"UIl1aDv 5yn Therapy time is for therapy. Anyone sustaining a double break like this would go directly to surgery. Saturday: 9am - 5pm Management of swelling and circulation, gentle working out of the other leg and upper body, maintenance of range of motion of the toes, ankle, knee and hip, are all important to the recovery process. Its not good to fall behind in the rehab schedule. Department of Rehabilitation Services Physical Therapy Standard of Care: Tibial Plateau Fracture Case Type / Diagnosis: ICD-9: 823.00 - fracture of proximal tibia Tibial plateau fractures can occur as a result of high-energy trauma or in low-energy trauma when bone quality is poor. At Rose Physical Therapy Group we offer one-on-one care, one-hour appointments and we accept insurance. Tel: 435-655-6600 b. The position of your tibial plateau makes it naturally built for high performance. 801-743-4500 These procedures are performed with great skill, and applying these skills in the right way can significantly decrease the time it takes to return to normal activity once the bone is healed. hWmo8+jqBmKs This initial healing period is extremely difficult because not putting weight on the bone causes atrophy of the surrounding muscles. The tibia, or shin bone, is the larger bone in your lower leg. NON WEIGHT BEARING PERIOD OF PHYSICAL THERAPY. Rehabilitation Protocol: Ankle Open Reduction Internal Fixation Name: _____ Date: _____ It's unusual to break both bones, even in contact sports like football. The key to all of this is the extra expertise that every Rose therapist has, its the secret sauce that makes everything work. Open reduction refers to open surgery to realign and set bone and is necessary for some fractures. Considerations for the Post-operative Ankle ORIF Many different factors influence the post-operative ankle ORIF rehabilitation outcomes, including rate of healing, complexity of the fracture and/or need for hardware removal. Internal fixation refers to the fixation of screws and / or plates to enable or facilitate healing. TIBIAL PLATEAU OPEN REDUCTION INTERNAL FIXATION (ORIF) Physical Therapy Protocol Patient Name: _____ Date of Surgery: _____ Procedure: Right / Left Tibial Plateau . For older individuals over an age of 50, additional risk factors include female gender, comorbidities and multiple medications. xw=$. You might need this procedure to treat your broken shin bone (tibia) or your fibula. On Thursday, October 27, from 7 p.m. to 10 p.m., BayCare Clinic will be updating its phone system. It takes quite a bit of trauma to break both of them at the same time. endstream endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <>stream REHABILITATION GUIDELINES FOR TIBIAL PLATEAU FRACTURE 2 | P a g e PHASE II (WEEKS 6-12) DATES: Appointments MD follow up at week 6 Continue physical therapy 2 x week Rehabilitation Goals Regain full knee ROM Normalize gait out of brace Strengthening of LE's and core Pain and edema control Wp 5_Am[a/@T]v5k S aypkeiw$)/p{yzSaqwekHOf$&M'6x )KZ)jr$"M,=gi, @nl= QydVV7.-_YgL.~f_i[Gr{h]_&7?23_]Lik5uMy?_0#MH#^|GwG]gigpmxV(|4Y&M>6nO>/Sn4>mw1K_4Q&2f`slom~!F\]v5OL^i+S2*iy2'+7l/kk0I97\Lsq"-*G+&dZLK"3g%3Kdm7JJrrR*Z0ZtY:q_Y12ZJ;2NLlFA1{eO Over time the workouts go from unloaded exercises like leg raises, to loaded exercises like squats to impact exercises like jumping. Physio.co.uk have clinics located throughout the North West. A broken bone is never fun. Calcific Tendinopathy of the Rotator Cuff, Medial Collateral Ligament Sprain of the Elbow, Entrapment of the Posterior Interosseous Nerve, Avulsion Fracture of the Ischial Tuberosity, Calcification of the Medial Collateral Ligament, Avulsion Fracture of the Base of the Fifth Metatarsal, Frozen Shoulder Release - Arthroscopic Release of the Coraco-Humeral Ligament, Rotator Cuff Surgery (Repair & Debridement), Lateral Epicondylitis Release (Tennis Elbow), Medial Epicondylitis Release (Golfer's Elbow), Micro-Fracture of an Osteochondral Lesion, Chronic Inflammatory Demyelinating Polyneuropathy, Difficulty With Fine or Gross Motor Skills, Benign Paroxysmal Positional Vertigo (BPPV), Instrument Assisted Soft Tissue Mobilisation (IASTM), Proprioceptive Neuromuscular Facilitation (PNF), Transcutaneous Electrical Nerve Stimulation (TENS), Hydrotherapy for Cardiovascular & Pulmonary Conditions, Hydrotherapy for Musculoskeletal Conditions, Constraint Induced Movement Therapy (CIMT), Post Surgical Rehabilitation for Children, Who is Suitable for Botulinum Toxin Injections, Who is Suitable for Thermoplastic Splinting, Non Invasive Positive-Pressure Ventilation (NIPPV), Instrument Assisted Soft Tissue Mobilisation, Increased endorphines, serototin, dopamine, Breakdown / realignment of collagen fibres, Who is suitable for our personal training. This is a time when staying in touch with the surgeon is important. a. Mon - Fri: 8am - 8pm The biggest factor is that the tibia is a weight bearing bone. Type B - Fractures at level of tibial plafond and typically extend proximally in a spiral or short oblique fashion. During this time, you may have difficulty reaching our clinics and offices. The tibial plateau is a strip of bone extending from your knee down to your shin. Initially physical therapy will include gentle strengthening and stretching. -{%0- -HL@ Z PRsl7!c,qV2"rQ+sNdEF@H,_e([XM-z> J=IV^(Px(/J,owPM8/A X>4/:vyDMcv=N[WiC1p,Ytsk_T- ZwQ_DFiC%X{as1RH1ykx=QEeD stream These are: smoking, diabetes, obesity, previous falls and/or fractures, very high or low levels of physical activity, and low bone mineral density (BMD). ORIF Tibia / Fibula Open Reduction and Internal Fixation (ORIF) of the lower leg is a surgical procedure to treat a fractured tibia and fibula. It takes quite a bit of trauma to break both of them at the same time. aB~Cw}I! %%EOF Any time a bone is broken we have to remove pressure on that bone to allow it to heal. Park City, Utah 84060 Download Patella ORIF Rehab Protocol Patella ORIF Rehabilitation Protocol Initial Restrictions: ROM: 0-90 x 4 weeks, 0-120 weeks 4-6, then progress as tolerated after 6 week clinic visit and cleared by physician Brace: Locked in extension x 6 weeks Weight Bearing Status: WBAT with crutches If you have any questions regarding this protocol, please contact the UGH Orthopedics and Sports Medicine Department at (706) 439-6858. The severity of the break can vary, but there are some standard things that anyone who breaks these bones will go through. Early range of motion exercises and early weight bearing should be encouraged. Patients will be in a hinged brace for support and to serve as a reminder not to weight-bear Seek full hyperextension equal to opposite side. Fortunately there are lots of resources, even for normal folks, to make recovery possible. 0 Immediate Postoperative/Max Protection Phase (Weeks 1-4) Goals: Restore full passive knee extension Diminish pain and joint swelling Restore patellar mobility *Control forces on repair site Postoperative Weeks 1-4 Brace: brace locked at 0 deg extension with compression wrap except for PT %PDF-1.3 All of this framework is important, but it shouldnt just be about the convenience of a clinic to your geographic location in the city, or your commute. CAUTION: Excessive warmth, redness, swelling, or pain lasting more than 2 days should necessitate a call to our office. Physiotherapy after ORIF surgery of the tibia/fibula is essential to mobilise and return function in the lower leg. Open Reduction and Internal Fixation (ORIF) of the lower leg is a surgical procedure to treat a fractured tibia and fibula. << /Length 5 0 R /Filter /FlateDecode >> Workouts that previously would have felt easy will be quite difficult. }t?g=q4CooMhG#N{iZO{`VKv4-f[$ Cw.=Phy n We have immediate appointments available today. Open reduction refers to open surgery to realign and set bone and is necessary for some fractures. 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